Using Antibiotics Wisely

Sep. 17, 2015, 12:00 am

By JIM O'NEILL

To solve the problem of antimicrobial resistance, the
world needs not only new drugs, but also new behavior – by all seven
billion of us. Because of the misuse and overuse of antibiotics, common
infections such as pneumonia and tuberculosis are becoming increasingly
resistant to existing treatments; in some cases, they have become
completely immune.

The threat is global in scale. According to the Review on Antimicrobial Resistance,
which I chair, drug-resistant infections kill at least 700,000 people
every year. By 2050, if nothing is done to address the problem, some ten
million people a year could be dying from maladies that were once
treatable.

Developing new drugs is an important approach in a coordinated
response to fight antimicrobial resistance. But it will not be enough.
We also need to reduce our demand for antibiotics and understand that
they can sometimes do more harm than good. According to one estimate,
nearly half of all prescriptions for antibiotics in the United States
are inappropriate or unneeded. So the steep rise in antibiotic
resistance is hardly surprising.

Improving people’s understanding of the problem will be crucial to reversing this trend. Most people are either completely oblivious to antimicrobial resistance or incorrectly believe
that it is an individual’s body that becomes drug resistant – not the
bacteria itself. A better understanding of when to use antibiotics, and
how to use them effectively, will help people use them responsibly.

We need campaigns like the one introduced by the Australian charity NPS MedicineWise, which held a competition for videos promoting public awareness of antibiotic use. The result was a series of short, witty films explaining simply and humorously how antibiotics can be misused.

These types of efforts are needed worldwide, particularly in the
largest and most rapidly growing countries. The BRIC countries – Brazil,
Russia, India, and China – consume fewer antibiotics per person than
the US. But they are rapidly catching up as the rate of antibiotics consumption outstrips the pace of economic growth.

Pessimists will claim that behaviors are hard to change, especially
when doing so depends on explaining the science of germs to uneducated
audiences. That line of thinking brings to mind one of the most
abhorrent arguments against making HIV medicines affordable for patients
in lower-income countries: People in Africa have no watches, so they
will not be able to take their antiretroviral medicine three times a
day.

The truth, as researchers have shown,
is that Africans are perfectly capable of reliably adhering to
antiretroviral therapy – often more so than North Americans. Indeed, in
July, UNAIDS announced that the goal of having 15 million people on life-saving HIV treatment by the end 2015 was met ahead of schedule.

Every year on December 1, World Aids Day highlights the issue and
raises global awareness. We need a similar effort to address the perils
of antimicrobial resistance. European Antibiotic Awareness Day, on November 18, is a good start; but we must also find new, creative ways to spread the message.

Technological innovation brings unprecedented opportunities to reach
people directly. Roughly 95% of Chinese and 75% of Indians use mobile
phones regularly. In areas where literacy rates are high, sending text
messages can be a rapid and effective way to spread a message. Research in Europe and the US shows that 90% of text messages are read within three minutes of being received.

Social media are another powerful and relatively cheap tool to reach
millions of people. In China – home to the world’s largest Internet
base, with 641 million users – 80 per cent of doctors use smartphones for
professional purposes, including by providing medical advice via social
media, with some practitioners attracting millions of followers.
Enlisting these medical social-media superstars to educate the public on
the urgency of antimicrobial resistance is an exciting opportunity.

An anti-smoking social-media campaign
led by the World Health Organization provides another model that could
be followed. Posts by Chinese celebrities were used to increase
awareness of a law banning smoking in indoor public spaces.

In some parts of the world, the best way to combat drug resistance
will be to encourage changes in behavior that reduce the spread of
infections and minimize the need for treatment. Proper hand washing is a
great place to start. In India, a clever campaign called SuperAmma
used images of people exposed to unsanitary situations to encourage
hand washing. The campaign successfully and sustainably increased
regular hand washing from one per cent of the groups involved to about 30 per cent.

The cost of a global effort to raise awareness of the threat of
antimicrobial resistance would be miniscule compared to the amount being
spent to develop new drugs and technologies, which in any case will
take years to become available. Countries should urgently put in place
educational campaigns and begin to change behaviors. Together, we can
break our bad antibiotic habits.

Jim O'Neill, a former chairman of Goldman Sachs Asset
Management, is Commercial Secretary to the UK Treasury, Honorary
Professor of Economics at Manchester University, a visiting research
fellow at the economic think tank Bruegel, and Chairman of the Review on
Antimicrobial Resistance. Copyright: Project Syndicate, 2015. www.project-syndicate.org.